The Etiology of Acute Scrotal Swelling on Surgical Exploration among Children and Adolescents in Jahra

Abstract

Objective: To describe the clinical presentation as well as the outcome of surgically explored acute scrotal swellings among children and adolescents recorded at the Al-Jahra Hospital, Kuwait during the period 1985–1995. Methods: Hospital records of 120 cases were reviewed. Results: Seventeen percent of the cases were found to be testicular torsions (TT) and 40% torsions of testicular appendages (TAT). Other etiologies included traumatic swelling (15%), idiopathic edema (13%), epididymo-orchitis (10%), hydroele (4%) and others (2%). Ages of patients ranged from 6 months to 18 years, averaging 9.3 years (SD = 2.9) for TAT cases and 10.1 years (SD = 6.4) for TT cases. Swelling and pain were located on the left side for 65% of the torsion cases. Direct trauma was reported in 22% of the torsion cases. In 90% of TT cases, orchidopexy was performed with success. Subsequent testicular atrophy occurred in only 1 patient who had symptoms for more than 48 h prior to surgery. Orchidectomy was directly performed on necrosed testes in a patient with signs lasting more than 48 h, and another patient with signs lasting 4 days. Conclusions: Primary health care physicians in Jahra district should continue to educate parents and adolescents to recognize the gravity of scrotal pain, and the importance of early response as a way of avoiding testicular necrosis.

The Acute Scrotum: A Review of 40 Cases

“…Our salvageability rate in testicular torsion was 81.8%, and the previously reported rates range between 26 and 90% [1,8] . Salvageability largely depends on the duration of pain at presentation [1] , and in our series the average duration was 2.6 h when the testis was salvaged and 48 h when the testis had to be removed.…”

“…Torsion of testicular appendage may be distinguished from testicular torsion by its more insidious onset and slightly longer duration of pain at presentation, presumably because this condition is less painful [2,6] . History of scrotal trauma (reported in 4-22% of patients with torsion) may be misleading [1,7,8] . Fever and dysuria are more common in epididymitis with reported incidences of 75 and 33%, respectively [9] , however, a small proportion of patients with testicular torsion may also have these symptoms [7] .…”

“…An aggressive approach is especially indicated in the younger patient, and when the duration of pain is short [1,5] . Education of the community is another important measure to reduce delayed presentation [8,14] . Salvageability also depends on the degree of twist and whether torsion is continuous or intermittent [1] .…”

Acute Scrotum in Children

“…Our salvageability rate in TT was 30.1% because of the late presentation time (mean, 70 hours; range, 2 hours to 10 days), and the previously reported rates range between 26% and 90%. 13,14 Salvageability largely depended on the duration of pain at presentation. Some degree of testicular atrophy was inevitable when pain is present for more than 8 to 12 hours, 15 and when pain was present for more than 24 hours, testicular salvageability was very low.…”

Epididymal Dirofilariasis in a Child: First Case Report from Bulgaria

“…The clinical features of human dirofilariasis are not specific. Since the resulting infectious nodule in the male genitalia is frequently indistinguishable clinically from a malignant neoplasm, when systemic signs are absent and urine analysis is negative, the nodule is usually removed surgically [6, 8]. …”